Double Mastectomy to Prevent Breast Cancer Reduces Risk of Dying from the Disease in BRCA1 Mutation Carriers – but Does Not Reduce Further the Already Low Risk in BRCA2 Carriers

Excerpt:

“Healthy women who carry a breast cancer-­causing mutation in the BRCA1 gene, not only reduce their risk of developing the disease but also their chances of dying from it if they have both breasts removed, according to new research presented today (Wednesday) at the 11th European Breast Cancer Conference.

“However, the study also found that for women with a mutation in the BRCA2 gene, there was no difference in their chances of dying from the disease whether they opted to have their breasts removed (bilateral risk-­reducing mastectomy or BRRM) or chose to have closer surveillance instead.”

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New ASTRO Guidelines Recommend Hypofractionated Breast Irradiation

Excerpt:

“An expert panel convened by the American Society for Radiation Oncology (ASTRO) released a set of recommendations regarding fractionation for whole-breast irradiation (WBI) in women with breast cancer. The guideline includes recommendations for standard practice, factors that should influence fractionation decision making, and issues surrounding tumor bed boost, among other issues.

” ‘Breast cancer is the most common malignancy treated with radiation therapy in the United States, and WBI is the most common radiotherapeutic approach for breast cancer,’ wrote authors led by Benjamin D. Smith, MD, of MD Anderson Cancer Center in Houston. The standard of care for WBI has involved conventional fractionation (CF), with daily doses of 180 to 200 cGy up to approximately 4,500 to 5,000 cGy; research in the 1990s and 2000s looked into whether moderate hypofractionation (HF) with daily doses of 265 to 330 cGy could offer similar outcomes.”

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CMS Starts to Cover Broad Cancer DNA Tests, Boosting Foundation, Thermo

Excerpt:

“The Centers for Medicare & Medicaid Services, which administers the federal Medicare insurance program, will begin covering FDA-approved diagnostic tests that scan tumors for a range of genetic mutations. The news is a boost for companies like Foundation Medicine and Thermo Fisher Scientific, who are among the few firms with such tests on the market.

“Late Friday, the CMS said that, going forward, it will start to reimburse for tests that use DNA sequencing technology to map the tumors of patients with advanced cancers once approved by the FDA. Two of the already-approved tests fitting this description are FoundationOne CDx, from Cambridge, MA-based Foundation, and Oncomine Dx Target Test, from Waltham, MA-based Thermo Fisher Scientific (NYSE: TMO). FoundationOne CDx looks for 324 cancer-related alterations in patients’ DNA. Foundation amasses a report based on the results and sends it to doctors, who use the data to suggest possible treatments. Oncomine detects 23 genetic alterations associated with non-small cell lung cancer.”

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Accelerated WBI Should be the Norm for Most Breast Cancers

Excerpt:

“Most women with breast cancer should receive accelerated whole-breast irradiation (WBI) as the standard of care, according to a new guideline from the American Society for Radiation Oncology (ASTRO).

“Accelerated, or hypofractionated, WBI is the preferred form of radiotherapy for breast cancer, regardless of a patient’s age, tumor stage, or whether the patient has received chemotherapy. The guideline replaces an ASTRO guideline published in 2011, which recommended hypofractionated WBI for selected patients: primarily older patients and those with less advanced disease.”

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AACR 2018: Acquired HER2 Mutations Confer Resistance to Hormone Therapy in ER-Positive Metastatic Breast Cancer

Excerpt:

“Mutations in HER2 were found to confer resistance to hormone therapy in some estrogen receptor (ER)-positive metastatic breast cancer cases, and resistance could be reversed by dual treatment with the hormone therapy fulvestrant (Faslodex) and the HER2 kinase inhibitor neratinib (Nerlynx), according to data presented during a media preview for the 2018 American Association for Cancer Research (AACR) Annual Meeting, to be held April 14–18 in Chicago.”

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Hurvitz Heralds Next HER2+ Breast Cancer Breakthroughs

Excerpt:

“The 5 FDA-approved HER2-targeted agents have altered the natural course of HER2-positive breast cancer, explained Sara A. Hurvitz, MD, at the 2018 Miami Breast Cancer Conference (MBCC).

” ‘These therapies have altered the way patients can now live with this disease,’ said Hurvitz, noting that the stage is now set for the next wave of treatment breakthroughs.”

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Neoadjuvant Endocrine Therapy Ideal for Some Breast Cancer Patients

Excerpt:

“Endocrine therapy can achieve tumor reduction for patients with ER-positive breast cancer, possibly avoiding the need for chemotherapy or even surgery in some patients; however, deciding how long to continue this therapy can be tricky, said Hyman B. Muss, MD, who presented at the 2018 Miami Breast Cancer Conference.

” ‘It can improve the probability of breast preservation for women who would appropriately fit in [related] studies and don’t have very high-grade or aggressive tumors,’ said Muss, of the Lineberger Comprehensive Cancer Center, University of North Carolina, and a 2017 Giants of Cancer Care® winner. ‘The optimal duration is 3 to 6 months. I think it’s [also] worth considering this in postmenopausal women with larger tumors.’ ”

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Olaparib Breast Cancer Efficacy Highlighted in Added Analyses

Excerpt:

“Improvements in progression-free survival (PFS) with olaparib (Lynparza) over treatment of physician’s choice (TPC) remained consistent regardless of baseline tumor burden for patients with HER2-negative breast cancer with a germline BRCA1/2 mutation (gBRCA1/2m), according to an exploratory analysis from the phase III OlympiAD trial presented at the 2018 Miami Breast Cancer Conference (MBCC).

“Although not powered to show statistical significance between the groups, in those with one metastatic site (n = 71) the median PFS with olaparib was 8.4 months compared with 4.2 months with TPC (HR, 0.62; 95% CI, 0.35-1.13). In patients with ≥2 metastatic sites (n = 231), the median PFS was 6.5 months with olaparib compared with 3.0 months for TPC, which crossed the barrier for statistical significance (HR, 0.59; 95% CI, 0.43-0.82).”

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Ribociclib Active Across Premenopausal Breast Cancer Subgroups

Excerpt:

“The progression-free survival (PFS) benefit for ribociclib (Kisqali) in pre- or perimenopausal women with hormone receptor–positive, HER2-negative advanced or metastatic breast cancer was sustained across patient subgroups, according to findings from the phase III MONALEESA-7 trial presented at the 2018 Miami Breast Cancer Conference.

“MONALEESA-7 randomized patients to either the CDK4/6 inhibitor ribociclib in combination with tamoxifen or a nonsteroidal aromatase inhibitor (NSAI; letrozole or anastrozole) plus goserelin (n = 335), or to endocrine treatment plus goserelin (n = 337). Across the overall study population, the median PFS was 23.8 months for the ribociclib arm compared with 13.0 months for the control arm (HR, 0.553; 95% CI, 0.441-0.694; P <.0001).”

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